"Yes, we have a way to stock up and send a sample of the patient's cerebrospinal fluid, but someone will do the experiment tomorrow." Gu Yanan explained.

"There's no hurry."

Gu Yanan was concerned about the condition of the woman in red and the results of various tests conducted on her by the hospital, but she couldn't say it clearly on the phone.

Gu Jiashu: "The details will be discussed when we have dinner together in the evening." ”

Gu Jiashu chose a restaurant close to the CDC, and when Gu Yanan arrived at the restaurant, Gu Jiashu was already waiting there.

Gu Jiashu beckoned to Gu Yanan, who had just entered the door, "Here." ”

Gu Yanan sat opposite, Gu Jiashu took the menu and handed it to Gu Yanan, and said, "I have ordered your favorite hot and sour fish and pomegranate juice, do you think you have anything else you want to eat?" ”

"What I like to eat, my brother knows it, you have already ordered it, you don't need to add more."

Gu Jiashu put down the menu with a smile.

Gu Yanan asked with some urgency, "Did you bring her medical records?" I would like to see the details. ”

"I knew you wanted to see it, so I took pictures of the medical records, and they're all here."

Gu Jiashu said, handing his mobile phone to Gu Yanan, he had taken all the examination reports and case files of the woman in red into electronic photos before leaving the hospital, and stored them in his mobile phone.

Gu Yanan looked at it, and Gu Jiashu explained, "Here are the examination and diagnosis records of the patients in our hospital, as well as the past medical records sent by the patient's husband.

Let's look at her past medical history first: the patient is usually in good health and denies underlying diseases such as hypertension, diabetes, coronary heart disease, and mental illness; denial of infectious diseases such as hepatitis and tuberculosis; denial of surgery as a history of trauma, blood transfusion; Denial of a history of food or drug allergies; Vaccinations are on schedule; Married and childbearing, denying a history of family genetic diseases and similar medical conditions.

History of present illness: The patient's family discovered that two months ago, in early July this year, the patient began to develop memory loss, poor sleep at night, and low-grade fever.

The patient's living habits gradually change, abnormal behaviors appear, such as not being able to use mobile phones and TVs correctly, sometimes brushing teeth for more than one hour, not distinguishing between urine and urine, going to the toilet for more than three hours, the patient often tells her husband that her neighbor's house is stealing her electricity, and when she sees the door of the house open, she is very nervous and wants to go out and rush out to catch the bad guys.

The patient did not have headache, dizziness, nausea, vomiting, cough, sputum production and other uncomfortable symptoms.

On July 3, the patient's husband took the patient to the neurology department of a hospital in our city, where he was diagnosed with depression and treated with oral medication for two weeks, but the effect was not good after treatment.

On July 17, the family took the patient to another mental health center, and the MRI of the head showed multiple lacunar foci in both frontoparial lobes and mild cerebral atrophy. Diagnosed with Alzheimer's disease. ”

When Gu Jiashu said this, Gu Yanan looked at the information on his mobile phone and asked rhetorically, "The patient is only 38 years old, how can it be Alzheimer's disease?" ”

Gu Jiashu: "That's the diagnosis of doctors in other hospitals, don't interrupt first, listen to me first."

After 10 days of treatment in that mental health center, the patient's behavior and language abnormalities did not improve significantly, and the patient's husband was about to be transferred to the hospital. ”

Gu Yanan said to herself, "I saw that her appearance in the woods was very abnormal at that time, and it turned out to be a lost patient. ”

Gu Jiashu continued, "After the patient enters our hospital, he undergoes a routine admission physical examination and various auxiliary examinations.

Routine physical examination showed confusion, inability to answer, inability to cooperate in physical examination, positive neck resistance, acceptable pupil light reflex, slightly pale conjunctiva, and no yellow staining of the sclera......"

Gu Yanan interrupted Gu Jiashu's words again, "I've seen all the physical examinations in the hospital, it's nothing, this auxiliary examination is really enough, blood routine, biochemistry, cerebrospinal fluid testing, immunity, urine routine, fecal routine, head CT, chest CT, upper and lower abdomen CT, electroencephalogram have all been done." ”

Gu Jiashu: "For such difficult cases, we will improve various examinations after the patient is admitted to the hospital, and so far, there is no evidence of bacterial, fungal, or viral central infection, no evidence of autoimmune encephalopathy, and no evidence of neoplastic diseases. ”

Gu Yanan: "Let you suspect that the patient is the cause of Creutzfeldt-Jakob disease, in addition to clinical symptoms, the main thing is to look at brain MRI examination and electroencephalogram, right?" ”

Gu Jiashu nodded, "Yes, the patient's head MRI can be seen, cortical DWI hyperintensity, showing typical streamer signs, and the EEG can show sharp waves and diffuse triphasic waves. ”

Gu Yanan read the medical record of the woman in red on her mobile phone from beginning to end, "Now it's just a cerebrospinal fluid 14-3-3 protein test." ”

Gu Jiashu agrees with Gu Yanan, "Although a positive 14-3-3 protein is not the gold standard for diagnosing CJD, a positive test, together with clinical manifestations and other laboratory tests, can make a diagnosis of CJD." ”

Gu Yanan: "Our CDC laboratory now uses immunoblotting to detect 14-3-3 protein, which takes a long time, and will give you the results as early as the morning after tomorrow. ”

Gu Jiashu sighed slightly, "Don't worry, if it's really Creutzfeldthorn disease, there is no treatment for this disease at present, and we can only do some symptomatic treatment for the patient." ”

Gu Yanan returned the mobile phone to his brother Gu Jiashu and analyzed: "Judging from the age and clinical symptoms of this patient, it belongs to variant Creutzfeldt-Jakob disease, and there is a possibility of iatrogenic transmission. ”

Gu Jiashu took the phone, put it aside, and promised: "Don't worry, I know the severity of Creutzfeldt-Jakob disease, and I have arranged the patient in a separate room in the infection department." The treating physician is also instructed to use a ** tool to mark the patient's secretions and tissues, avoid direct contact with the patient's blood and infected tissues, and avoid direct penetrating injuries during nursing examination and treatment. ”

Gu Yanan still admires Gu Jiashu's medical professionalism, "Well, my brother has done a good job, you have to protect yourself before treating patients." ”

Gu Jiashu patted his little sister's head dotingly, "Sister, don't worry about me first, I think you should worry about yourself, if this case is really Creutzfeldt-Jakob disease, you will have to do a flow investigation, right?" On-site epidemiological investigations can be a dangerous task. ”

While the two were talking, the waiter had already brought hot and sour fish and rice.

Gu Jiashu handed the chopsticks to Gu Yanan, Gu Yanan unceremoniously ate two bites before he began to say: "If it is Creutzfeldt, our disease control and control will indeed do an epidemiological investigation, brother, have you asked the patient if he has been in contact with the source of infection related to Creutzfeldt-Jakob disease?" ”

Gu Jiashu gave Gu Yanan a piece of tender meat next to the gills of chopsticks, and replied: "I have asked, and the patient's family denies that they have recently eaten beef from the mad cow disease-affected area. ”